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Deogaonkar and Elliott report the interesting case of a patient who
developed transverse nail ridges after fracturing the ulna with associated
ulna nerve neuropraxia (1). Whilst nail growth can be affected by nerve
injury, this is unlikely to have been the cause in this case. Careful
analysis of the image shows that the fingernails of little, ring, middle
and (to a lesser degree) index fingers are all affected. The nailbeds are
typically innervated by the dorsal terminal branches of the proper digital
arteries (2), with the ulna nerve innervating the dorsal surfaces of the
ulna one and a half fingers and the median nerve innervating the dorsum of
the remaining fingers (3). Hence an ulna nerve neuropraxia would only be
expected to result in altered growth of the little and ring fingernails.
The transverse nail ridges are more likely to be Beau's lines which have
been described after trauma (local and remote) and systemic disease.
References
(1)Deogaonkar KJ, Elliott J. Minerva. BMJ 2008; 336: 1026.
(2)Zook EG, Van Beek AL, Russell RC, Beatty ME. Anatomy and
physiology of the perionychium: a review of the literature and anatomic
study. J Hand Surg 1980; 5(6): 528-36.
(3)Laroy V, Spaans F, Reulen J. The sensory innervations pattern of
the fingers. J Neurol 1998; 245: 294-298.
Competing interests:
None declared
Competing interests:
No competing interests
05 May 2008
Andrew N Morritt
SPR in Plastic Surgery
Department of Plastic Surgery, Northern General Hospital, Sheffield, S5 7AU
Ulna nerve neuropraxia unlikely to be responsible for nail growth arrest
Sir,
Deogaonkar and Elliott report the interesting case of a patient who developed transverse nail ridges after fracturing the ulna with associated ulna nerve neuropraxia (1). Whilst nail growth can be affected by nerve injury, this is unlikely to have been the cause in this case. Careful analysis of the image shows that the fingernails of little, ring, middle and (to a lesser degree) index fingers are all affected. The nailbeds are typically innervated by the dorsal terminal branches of the proper digital arteries (2), with the ulna nerve innervating the dorsal surfaces of the ulna one and a half fingers and the median nerve innervating the dorsum of the remaining fingers (3). Hence an ulna nerve neuropraxia would only be expected to result in altered growth of the little and ring fingernails. The transverse nail ridges are more likely to be Beau's lines which have been described after trauma (local and remote) and systemic disease.
References
(1)Deogaonkar KJ, Elliott J. Minerva. BMJ 2008; 336: 1026.
(2)Zook EG, Van Beek AL, Russell RC, Beatty ME. Anatomy and physiology of the perionychium: a review of the literature and anatomic study. J Hand Surg 1980; 5(6): 528-36.
(3)Laroy V, Spaans F, Reulen J. The sensory innervations pattern of the fingers. J Neurol 1998; 245: 294-298.
Competing interests: None declared
Competing interests: No competing interests